种族、民族和手术取消之间的关系：一项对接受肿瘤手术的患者队列的回顾性研究

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-07-07 DOI:10.1016/j.jclinane.2025.111925

Juan P. Cata MD , Pascal Owusu-Agyemang MD , Taiwo Adesoye MD , Lei Feng MS

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引用次数: 0

摘要

背景：手术延误和取消在少数种族和少数民族患者中更为常见。我们假设种族和民族是癌症患者手术取消的独立危险因素。方法回顾性分析某大型三级肿瘤中心的外科手术。主要结局是在预定手术日期之前或当天手术取消。主要暴露变量是患者自我报告的种族和民族。拟合了一个多变量逻辑回归模型来估计协变量对病例取消状态的影响。p值<；0.05被认为具有统计学意义。结果109400例手术中，手术总取消率为4.45%。以头颈科患者发生率最高（15.04%）。总的来说，治疗的改变是取消治疗的常见原因（54.9%）。黑人患者的取消率在所有种族中最高（5.4%），其中乳房外科肿瘤服务的取消率在黑人患者中最高（16.6%）。在以手术日期为聚类变量的混合效应模型中，仅纳入每位患者独特的首次临床就诊（N = 78,227），并调整性别、年龄调整CCI和原发手术类型后，确定为NH-Asian （OR, 99.8% CI: 0.56, 0.40-0.79）和NH-White （OR, 99.8% CI: 0.64, 0.53-0.78）的患者与NH-Black患者相比，手术取消的几率具有统计学显著性降低。被确定为NHPIA （OR, 99.8% CI: 0.57, 0.22-1.51）、西班牙裔或拉丁裔（OR, 99.8%: 0.82, 0.65-1.03）和其他（OR, 95% CI: 0.76, 0.46-1.26）的患者与NH-Black患者相比，手术取消的几率并没有显著降低。结论我们的研究表明，在癌症治疗的背景下，黑人或非裔美国人患者手术取消的风险增加。

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Association between race, ethnicity, and surgical case cancellations: A retrospective study in a cohort of patients undergoing oncological surgeries

Background

Surgical delays and cancellations have been shown to occur more frequently in racial and ethnic minority patients. We hypothesized that race and ethnicity are independent risk factors for surgical cancellations in patients with cancer.

Methods

This retrospective study reviewed surgical procedures in a large tertiary cancer center. The primary outcome was surgical cancellation before or on the intended surgery date. The primary exposure variable was a patient's self-reported race and ethnicity. A multivariable logistic regression model was fitted to estimate the effects of covariates on the status of case cancellation. A p-value <0.05 was considered statistically significant.

Results

Of 109,400 surgical cases, the overall rate of cancellation was 4.45 %. The highest rate was among patients in the head and neck service (15.04 %). Overall, changes in treatment were a frequent cause of cancellations (54.9 %). Black patients had the highest rate of cancellations among all ethnicities (5.4 %), with the breast surgical oncology service having the highest rate of cancellations among Black patients (16.6 %). After only including unique first clinical encounters of each patient (N = 78,227) and with adjustment of gender, age-adjusted CCI and primary surgery type in a mixed effects model which treated surgery date as a cluster variable, patients identified as NH-Asian (OR, 99.8 % CI: 0.56, 0.40–0.79), and NH-White (OR, 99.8 % CI: 0.64, 0.53–0.78) had statistically significant lower odds of surgical cancellation compared to NH-Black patients. Those identified as NHPIA (OR, 99.8 % CI: 0.57, 0.22–1.51), Hispanic or Latino (OR, 99.8 %: 0.82, 0.65–1.03), and Other (OR, 95 % CI: 0.76, 0.46–1.26) did not have significant lower odds of surgical cancellation compared to NH-Black patients.

Conclusions

Our work suggests that in the context of cancer care, Black or African-American patients have an increased risk of surgical cancellations.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.